spine杂志01上半期摘要翻译

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1、indexBasicScienceEffectof Polyether Ether Ketone on Therapeutic Radiation to theSpine:APilotStudy聚醚醚酮树脂PEEK对脊柱放射治疗的影响：初步研究Deletion of Opg Leads to Increased Neovascularization andExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因导致腰椎间盘中炎症细胞因子的表达和新生血管形成的增加indexCervicalSpine

2、ComplicationandReoperationRatesFollowingSurgicalManagementofCervicalSpondyloticMyelopathyinMedicareBeneficiaries医疗保险受益人髓性颈椎病手术治疗后的并发症和再手术率EfficacyofDiffusionTensorImagingIndicesinAssessingPostoperativeNeuralRecoveryinCervicalSpondyloticMyelopathy扩散张量成像指数在评估颈椎脊髓病性脊髓病术后神经恢复的功效RoutineUseofIntraoperativ

3、eNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395Cases在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回顾15,395例indexClinicalCaseSeriesRoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:A

4、Reviewof15,395Cases在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回顾15,395例DermalDiscolorationsandBurnsatNeuromonitoringElectrodesinPediatricSpineSurgery儿科脊柱手术使用神经电极导致皮肤色素沉着和烧伤PreventiveEffectofDynamicStabilizationAgainstAdjacentSegmentDegenerationAfterPosteriorLumbarInterbodyFusion动态稳定对后路腰椎间融合后相邻节段退变的预防效果Lumbar Deg

5、enerative Spondylolisthesis: Changes in Surgical Indications andComparisonofInstrumentedFusionWithTwoSurgicalDecompressionProcedures腰椎退行性脊椎滑脱：手术适应症的变化和两种减压手术的比较INDEXDeformityDiscrepancy Between Standing Posture and SagittalBalance During Walking in Adult Spinal DeformityPatients成年脊柱畸形患者行走和站立姿势矢状平衡之间

6、的差异Function and Clinical Symptoms are the Main FactorsthatMotivateThoracolumbarAdultScoliosisPatientstoPursueSurgery功能和临床症状是促使成人胸腰椎脊柱侧凸患者进行手术的主要因素INDEXEpidemiologyFrequencyandRiskFactorsforAdditionalLesionsintheAxial Spine in Subjects With Chordoma:Indications forScreening脊柱脊索瘤患者脊柱轴向其他病变的频率和危险因素Heal

7、thServicesResearchThe Influence of Race on Short-term Outcomes AfterLaminectomyand/orFusionSpineSurgery种族对椎板切除和/或融合脊柱手术后短期结果的影响INDEXLiteratureReviewASystematicReviewoftheSoft-TissueConnectionsBetweenNeckMusclesandDuraMater:TheMyoduralBridge连接颈部肌肉和硬脑膜之间的软组织的系统评价：肌肉桥OutcomesComparison of Outcomes of S

8、ingle-Level Anterior CervicalDiscectomy With Fusion and Single-Level Artificial Cervical DiscReplacementforSingle-LevelCervicalDegenerativeDiscDisease单节段前路颈椎椎间盘切除融合术和单节段颈椎椎间盘置换术对单节段颈椎退行性椎间盘疾病的预后比较INDEXPerioperative Complications in 155 Patients Who UnderwentOblique Lateral Interbody Fusion Surgery:

9、Perspectives andIndicationsFromaRetrospective,MulticenterSurvey155例OLIF患者的围手术期并发症SurgicalSiteInfectionsinPosteriorLumbarSurgery:AControlled-CohortStudyofEpiduralSteroidPaste后路腰椎手术切口感染：控制性队列研究硬膜外类固醇使用Canadian Consensus for the Prevention of Blood Loss in SpineSurgery加拿大对预防脊柱手术出血的共识Metallosis Presenti

10、ng as a Progressive Neurologic Deficit FourYears After a Posterior Spinal Fusion for Adolescent IdiopathicScoliosis:ACaseReport金属沉着导致青少年特发性脊柱侧凸后路脊柱融合术四年后渐进性的神经功能障碍：病例报告TITLEEffect of Polyether Ether Ketone onTherapeuticRadiationtotheSpine:APilotStudy聚醚醚酮树脂PEEK对脊柱放射治疗的影响：初步研究StudyDesign.Cadavericmode

11、l.研究设计：尸体模型。ABSTRACTObjectives. To compare the effect ofPEEKversusconventionalimplantsonscatterradiationtoasimulatedtumorbedinthespine目的：比较PEEK与传统植入物对脊柱模拟放射治疗的影响ABSTRACTSummaryofBackgroundData.Giventhehighlyvasculaturenatureofthespine, it is the most common place for bony metastases. After surgicalt

12、reatment of a spinal metastasis, adjuvant radiation therapy is typicallyadministered.Radiationdosingisprimarilylimitedbytoxicitytothespinalcord.Thescattereffectcausedbymetallicimplantsdecreasestheaccuracyofdosingandcanunintentionallyincreasetheeffectivedoseseenbythespinalcord.Thisrepresentsadose-lim

13、itingfactorfortherapeuticradiationpostoperatively.背景资料概述：由于椎体的血运丰富，所以是骨转移最常发生的部位。脊柱转移癌的外科治疗后，通常需要辅助放射治疗。辐射剂量主要受脊髓毒性的限制。金属植入物引起的散射效应降低剂量的准确性，并可以无意中增加脊髓的有效剂量。这代表术后放射治疗的剂量限制因素。ABSTRACTMethods.Acadavericthoraxspecimenwasutilizedasametastatictumormodelwithtwoseparatethree-levelspineconstructs(oneuppertho

14、racicandonelowerthoracic).Eachconstructwasexaminedindependently. Allfour groups compared included identical posterior instrumentation. Theanteriorconstructsconsistedofeither:ananteriorpolyetheretherketone(PEEK) cage, an anterior titanium cage, an anterior bone cement cage(polymethylmethacrylate),ora

15、controlgroupwithposteriorinstrumentationalone.Eachconstructhadsixthermoluminescentdetectorstomeasuretheradiationdose.方法：使用尸体胸部标本作为具有两个完整脊柱三柱构造（一个上胸椎和一个下胸椎）的转移性肿瘤模型。独立地检测每个构建体。所有四组比较包括相同的后路内固定物。前柱固定使用：前聚醚醚酮（PEEK），钛笼，骨水泥笼（聚甲基丙烯酸甲酯）或仅有后路内固定的对照组。每个构建体用六个热释光检测器以测量辐射剂量。ABSTRACTResults. The mean dose was s

16、imilar across all constructs andlocations. There was more variability in the upper thoracic spineirrespectiveoftheconstructtype.ThePEEKconstructhadamoreuniform dose distribution with a standard deviation of 9.76. Thestandarddeviationoftheothersconstructswas14.26forthecontrolgroup, 19.31 for the tita

17、nium cage, and 21.57 for the cement(polymethylmethacrylate)construct.结果：所有构建体和位置的平均剂量相似。无论内固定类型如何，上胸椎存在更多的变异性。PEEK构建体具有更均匀的剂量分布，标准偏差为9.76。其他构建体的标准偏差：对照组为14.26，钛笼为19.31，骨水泥（聚甲基丙烯酸甲酯）构建体为21.57。ABSTRACTConclusion. The PEEK inter-body cage resulted in asignificantly more uniform distribution of therapeu

18、ticradiation in the spine when compared with the otherconstructs.Thismayallowfortheapplicationofhighereffectivedosingtothetumorbedforspinalmetastaseswithout increasing spinal cord toxicity with eitherfractionatedorhypofractionatedradiotherapy.结论：与其他构建体相比，PEEK笼手术后放射治疗的辐射在脊柱中有更显着均匀的分布。这可以允许对脊柱转移肿瘤施加更高

19、的有效剂量，而不增加放疗的脊髓毒性。Sampleradiationplanningmodelcreatedfrom a planningCT scanfor oneof ourcadavericspecimens.Theseparateiso-denselinescanbeseenwiththepercentageofthetotaldoseadministered.Theyellowareaisthespinalcordthathasbeenselectedduringtheradiationplanningasanareatoprotect.Notetherediso-denselines

20、,representing100%dose,lackofuniformdistributioninthePMMAconstructanditsoverlapwiththespinalcord.Aclinicalphotographofarepresentativeconstructwiththeposteriorspinalrods(bluearrow),thecircumferentiallydecompressedspinalcord(whitearrow),andthePMMAanteriorconstruct(yellowarrow).B,Aclinicalphotographafte

21、rthesensorswereplacedintheirrespectivetrocarandthenplacedintheback.Thetrocarswereplacedthroughtheskintoallowformoresecurepositioning.Eachtrocarwaslabeledforaccuraterecoveryofthesensorfromitscorrespondinglocation.AcartonrepresentationoftheTLDsensorplacementlocation.EachTLDsensorplacementwasconfirmedv

22、isuallybeforeclosingtheincisionandfillingitwiththephantommaterial.RepresentativeimagesfromacompleteplanningCTscanwithbeamanglesandiso-denselinesillustrated.Coronal,sagittal,axial,and3Dimagesareincluded.Thephantomcanbeseeingfillingthelungs.Thelowerconstructdosingwasplannedseparately.ArepresentativeT2

23、sagittalMRIofapatientafterposteriorinstrumentationandanteriorreconstructionwithaPEEKcage.Notethescatterwiththepediclesscrews(redarrows).ThePEEKcagehasminimalscatteraffectingtheimagingsequence(yellowarrow).RepresentativeaxialCTscanimagesdemonstratingthedifferenceinscattereffectfromametalanteriorconst

24、ruct(A)versusaPEEKanteriorconstruct(B).*Despiteadvances,metastaticdiseasecontinuestoaffectthespineanditcancausesymptomsfrompainandweaknesstocompleteparalysisleadingtosignificantmorbidityanddisability*尽管取得进展，但转移性疾病任然影响脊柱，并且可引起疼痛和无力，甚至完全瘫痪*ThePEEKinterbodycageresultedinasignificantlymoreuniformdistrib

25、utionoftherapeuticradiationinthespinewhencomparedwiththeotherconstructsinacadavericspinemodel.*与尸体脊柱模型中的其他内固定构造相比，PEEK椎间融合器的治疗辐射在脊柱中有更加显着均匀的分布。*Thisknowledgemayallowfortheapplicationofhighereffectivedosing tothetumorbed forspinal metastaseswithout increasingspinal cord toxicity with either fractiona

26、ted or hypofractionatedradiotherapy.*这种知识可以对脊柱转移的肿瘤应用更高的有效剂量，而不增加放疗的脊髓毒性。TITLEDeletion of Opg Leads to Increased Neovascularization andExpressionofInflammatoryCytokinesintheLumbarIntervertebralDiscofMice敲除小鼠Opg基因导致腰椎间盘中炎症细胞因子的表达和新生血管形成的增加StudyDesign. Neovascularization and expression ofinflammatoryc

27、ytokineswereexaminedinOsteoprotegerin(Opg)knockout(KO)micethatshowintervertebraldisc(IVD)degeneration.研究设计：研究骨保护素（Opg）敲除（KO）小鼠的椎间盘（IVD）变性模型中炎症细胞因子的表达和新血管的形成。ABSTRACTObjective. The aim of this study was toclarifythepathologicalchangesinlumbarIVDdegenerationinOpgKOmice.目的：本研究的目的是阐明OpgKO小鼠腰椎IVD变性的病理变化。

28、ABSTRACTSummaryofBackgroundData.OsteoporosisisacontroversialriskfactorforIVDdegeneration.DeletionofOpgresultedinIVDdegenerationinmice.NeovascularizationandinflammatorycytokinesarekeyfactorsinIVDdegeneration.背景数据概述：骨质疏松是IVD变性的有争议的风险因素。敲除Opg导致小鼠中的IVD变性。新血管形成和炎症细胞因子是IVD变性的关键因素。ABSTRACTMethods.OpgKOmice

29、andtheirwild-type(WT)littermateswereeuthanized.LumbarIVDswereharvested.SafraninO/FastGreenstainingwasperformedtoexaminethepathological changes. Microcomputed tomographic (micro-CT) analysis wasperformedtodeterminethestructuralchangesatthejunctionoflumbarIVDcartilageandvertebrae.Tartrate-resistantaci

30、dphosphatase(TRAP)stainingwasperformedtoevaluate osteoclast formation. Protein expression of vascular endothelial growthfactor A (VEGF-A), CD31, VE-cadherin, CD 34, interleukin-1 (IL-1), and tumornecrosisfactors(TNF-)wereanalyzedbyimmunohistochemistry(IHC)assays.GeneexpressionsofIL-1,IL-6,andTNF-wer

31、eanalyzedbyreal-timepolymerasechainreaction(RT-PCR).方法：将OpgKO小鼠及其野生型（WT）同窝小鼠安乐死。获取腰部IVD。进行SafraninO/FastGreen染色以检查病理变化。进行微计算机断层扫描（micro-CT）分析以确定腰椎IVD软骨和椎骨的连接处的结构变化。进行酒石酸盐抗性酸性磷酸酶（TRAP）染色以评价破骨细胞形成。通过免疫组织化学（IHC）测定分析血管内皮生长因子A（VEGF-A），CD31，VE-钙粘蛋白，CD34，白细胞介素-1（IL-1）和肿瘤坏死因子。通过实时聚合酶链反应（RT-PCR）分析IL-1，IL-6和T

32、NF-的基因表达。ABSTRACTResults. In 12-week-old Opg KO mice, new bone was formed in the endplatecartilageoflumbarIVDsandthisbecamemoreobviousin24-week-oldOpgKOmice.Three-dimensional(3D)CTreconstructionanalysesshowedthattheedgesoftheL4andL5vertebraewereruggedwithbonemarrowcavitiesinit.ProteinexpressionofVEG

33、F-A,CD31,VE-cadherin,andCD34wasincreasedintheendplateandgrowthplateoflumbarIVDsofOpgKOmice.GeneexpressionofIL-1,IL-6,andTNF-aswellasproteinexpressionofIL-1andTNF-werehighlyexpressedinthelumbarIVDsofOpgKOmice.结果：在12周龄的OpgKO小鼠中，腰椎IVD的终板软骨中形成新骨，这在24周龄的OpgKO小鼠中变得更明显。三维（3D）CT重建分析显示，L4和L5椎骨的边缘与骨髓腔骨质增生。在Op

34、gKO小鼠的腰椎IVD的终板和生长板中VEGF-A，CD31，VE-钙粘着蛋白和CD34的蛋白表达增加。IL-1，IL-6和TNF-的基因表达以及IL-1和TNF-的蛋白表达在OpgKO小鼠的腰部IVD中高度表达。ABSTRACTConclusion. Deletion of Opg leads toincreasedneovascularizationandexpression of inflammatory cytokines inthe lumbar disc in Opg KO mice, whichmayplayimportantrolesinIVDdegeneration.结论：O

35、pg的缺失导致OpgKO小鼠腰椎间盘的新血管形成和炎症细胞因子的表达增加，这可能在IVD变性中起重要作用。Newbonewasformedintheendplatecartilageofthelumbar4/5IVDsinOpgKOmice.(A)SafraninOandFastGreenstainingshowedthatthenewbonewasfoundattheedgeoftheendplatecartilagein12-week-oldOpgKOIVDs(arrow,middlepanel),andwasdevelopedthroughouttheendplatecartilagei

36、n24-week-oldOpgKOIVDs(arrowheads,rightpanel).Thegrowthplatebecamethinner(arrow,rightpanel).(B)Newboneformationwasquantifiedbytheratioofnewboneareaandendplatecartilageareainlumbar4/5IVDs.Inboth12-week-oldand24-week-oldmice,newboneformationinendplatecartilageofOpgKOIVDswassignificantlyincreasedthantha

37、tofWTIVDs(P0.01).n=3.(C)3Dreconstructionanalysisfromthetransversepositionshowedthatin12-week-oldOpgKOmice,newcavitiesappearedontheedgesoftheL4andL5vertebrae.In24-week-oldOpgKOmice,thevertebraebecameevenruggedwithalotofcavitiesinit(pixelsize:906x906).*DeletionofOpgleadstoincreasedneovascularizationin

38、lumbarintervertebraldiscofmice.* Deletion of Opg leads to increased expression of inflammatorycytokinesinlumbarintervertebraldiscofmice.*LumbarIVDdegenerationinOpgKOmicecouldbeacceleratedbytheinteractionsamongosteoclastformation,inflammatorycytokines,andneovascularization.*敲除Opg导致小鼠腰椎间盘增加新血管形成。*敲除Op

39、g导致小鼠腰椎间盘中炎症细胞因子的表达增加。*OpgKO小鼠的腰椎IVD变性可以通过破骨细胞形成，炎症细胞因子和新血管形成之间的相互作用而加速。TitleComplication and Reoperation Rates Following Surgical Management of Cervical Spondylotic Myelopathy in Medicare BeneficiariesDepartment of Orthopaedic Surgery, Johns HopkinsHospital,Baltimore,MD医医疗疗保保险险受受益益人人髓髓性性颈颈椎椎病病手手术术治

40、治疗疗后后的的并并发发症症和和再再手手术术率率StudyDesign.Retrospectivedatabasereview.研究设计：回顾性数据库审查。研究设计：回顾性数据库审查。ABSTRACTObjective. To compare complication and reoperationrates after anterior cervical discectomy and fusion(ACDF), posterior cervical fusion (PCFs), and anteriorcervical corpectomy and fusion (ACCF) for cerv

41、icalspondylotic myelopathy (CSM) using a large nationaldatabaseofMedicarebeneficiaries.目的：使用国家医疗保险受益人的大型国家数据库，比较颈椎前路椎间盘切除融合术和颈椎后路融合术（PCF），颈椎前路椎体融合术（ACCF）治疗颈椎髓性颈椎病（CSF）的并发症和再手术率。ABSTRACTSummary of Background Data. CSM is the mostcommoncauseofmyelopathyinpatientsover55yearsandisconsideredthemostcommon

42、causeofspinalcorddysfunction in the world. Surgical treatment includesACDF,PCF,orACCFprocedures.背景资料概述：CSM是55岁以上患者中脊髓压迫最常见的原因，并且被认为是世界上导致脊髓功能障碍的最常见原因。手术治疗包括ACDF，PCF或ACCF。ABSTRACTMethods. The PearlDiver database (20052012) was utilized todeterminerevisionratesaftersurgicaltreatmentofCSMbyoneofthe afo

43、rementioned surgical treatments. Specifically, 1 to 2 levelACDF,ACCF,andPCFand3+levelPCFcohortswereincluded.Each cohort was stratified by the age of 65 years. Survivorshipcurvesweregraphedandcompared.方法：使用PearlDiver数据库（2005-2012）确定上述手术治疗的CSM患者的返修率。具体来说，包括1至2阶段ACDF，ACCF和PCF和3+PCF队列。每个队列按65岁分层。绘制并比较存活

44、曲线。ABSTRACTResults.Ofthepatientsyoungerthan65yearsofage,therewere10,557patientstreatedwith1to2levelACDFprocedures,1319patientswith1to2levelPCFprocedures,1203patientswith1to2levelACCFprocedures,and2312patientstreatedwith3+levelPCFprocedures.Oftheelderlypatients, 24,310 patients were treated with 1 to

45、 2 level ACDFs, 4776 with 1 to 2 level PCFprocedures,3109with1to2levelACCFs,and7760with3+levelPCFs.Patientsyoungerthan65yearsofageweresignificantlymorelikelytohaveareoperationprocedure,thanthose65yearsorolderwhenanalyzingACCF,ACDF,and3+levelPCFprocedures.ACCFsweresignificantlymorelikelythanACDFstore

46、quirereoperation.PatientstreatedwithPCFwereconsistentlymorelikelytohavenondysphagia-relatedcomplicationsthanthosetreatedwithACDF.Ratesoftransfusion,dysphagia,andhematoma/seromaformationweresignificantlyincreasedwithACCFcomparedwithACDFwithintheelderlypopulation.结果：在65岁以下的患者中，有10,557例患者接受12阶段的ACDF手术，

47、1319例患者接受12阶段的PCF手术，1203例患者接受12阶段的ACCF手术，2312例患者接受3+级PCF程序。在老年患者中，24,310例患者接受12阶段的ACDF治疗，4776例接受12阶段的PCF手术，3109例接受12阶段的ACCF，7760例接受34阶段的PCF。65岁以下的患者ACCF，ACDF和3+级PCF比65岁或更大的患者明显更有可能进行再次手术。ACCF明显比ACDF更可能需要再次手术。PCF治疗的患者比用ACDF治疗的患者更可能患有非吞咽困难相关的并发症。输血，吞咽困难和血肿形成率在老年人口中的ACDF组显着增加。ABSTRACTConclusion. The el

48、derly are significantlylesslikelytohavearevisionsurgeryaftersurgical treatment for CSM. PatientstreatedwithACCFaremorelikelytoneedarevisionthanthosetreatedwithACDF.结论：老年人在CSM手术治疗后进行返修手术的可能性显着降低。用ACCF治疗的患者比用ACDF治疗的患者更可能需要翻修。* Patients treated with ACCF are more likely to needrevisionsurgerythanthoset

49、reatedwithACDForPCF.*ThereisnosignificantdifferenceinrevisionratewhencomparingACDFandPCFprocedures.*Theelderlyweresignificantlylesslikelythanyoungerpatientstohavearevisionsurgerywhenconsideringallsurgeries.* PCF is associated with greater complication rates,thoughlowerdysphagiarates.*ACCF治疗的患者比ACDF或

50、PCF治疗的患者更可能需要翻修手术。*当比较ACDF和PCF程序时，翻修率没有显着差异。*在考虑所有手术时，老年人比年轻患者进行翻修手术的可能性显着降低。*PCF与较高的并发症发生率相关，但吞咽困难率较低。TITLEEfficacyofDiffusionTensorImagingIndicesinAssessingPostoperative Neural Recovery in Cervical SpondyloticMyelopathyDepartmentofspinesurgery,GangaHospital,Coimbatore,India.扩散张量成像指数在评估颈椎脊髓病性脊髓病术后神

51、经恢复的功效StudyDesign.Prospectiveobservationalcohortstudy.研究设计：前瞻性观察性队列研究。ABSTRACTObjective. The aim of this study was to analyze the efficacy ofdiffusion tensorimaging (DTI)anisotropy indices in predicting thepostoperative recovery in cervical spondylotic myelopathy (CSM)patientsandtodescribepostoperat

52、ivechangesintheDTIindicesbasedonneurologicalrecoveryaftersurgery.目的：本研究的目的是分析扩散张量成像（DTI）各向异性指数在预测颈髓性脊髓病（CSM）患者的术后恢复的效果，并描述手术后神经恢复的DTI指数的术后变化。ABSTRACTSummary of Background Data. Surgical results of CSM areunpredictableandcannotbeestimatedbasedonpreoperativeMRI.DTIindiceswerefoundtohavegoodsensitivity

53、todetectchangesinCSM, but their efficacy in predicting postoperative recovery andpostoperativechangesinDTIindiceshasnotbeenstudiedbefore.背景资料总结：CSM的手术结果是不可预测的，不能基于术前MRI进行估计。DTI指数具有良好的敏感性以检测CSM的变化，但DTI指数术后变化在预测术后恢复的功效尚未进行过研究。ABSTRACTMethods.Thirty-fivepatientswhounderwentsurgicaldecompressionforcervi

54、calspondyloticmyelopathyunderwentDTIevaluation preoperatively and postoperatively at 12 months. DTIindicesfractionalanisotropy,apparentdiffusioncoefficient(ADC),relative anisotropy, volume ratio, and eigen vectors (E1, E2, andE3)wereobtainedandclinicalevaluationsweremadepreoperativelyand12monthspost

55、operatively.方法：35例颈椎病接受手术减压的患者术前和术后12个月进行DTI评估。获得DTI指数-分数各向异性，表观扩散系数（ADC），相对各向异性，体积比和特征向量（E1，E2和E3），并在术前和术后12个月进行临床评价。ABSTRACTResults. Twenty-six patients were available for final follow-up at 12 months. Twenty patientsshowedimprovementbyatleast1Nurickgrade,fivemaintainedthepreoperativeNurickgradest

56、atusandonepatientwasnotedtohavedeteriorationby1grade.ThepreoperativeDTIvaluescould not predict neurological recovery patterns postoperatively. Although conventional MRIshowedadequatedecompressioninallpatientsirrespectiveoftheclinicaloutcome,DTIindicesshowedvariableresults.Thereweresignificantimprove

57、mentsinpostoperativeDTIindicesforADC(P=0.002),E1(P0.001),andE2(P=0.012)valuesinpatientswhoshowedneurologicalrecovery at 12 months. Postoperative DTI indices for coefficients ADC, E1, and E2 inneurologicallystatic/worsenedindividualsremainedunchangedorinsignificant(P=0.05)结果：在12个月时有26名患者获得了最终随访。20例患者

58、表现出至少1级的Nurick改善，5例维持术前Nurick分级状态，1例患者1级恶化。术前DTI值无法预测术后神经恢复。尽管常规MRI在所有患者中显示充分的减压，而不管临床结果如何，但DTI指数显示可变的结果。在12个月时显示神经恢复的患者中，ADC（P=0.002），E1（P0.001）和E2（P=0.012）值的术后DTI指数有显着改善。在神经静态/恶化个体中，ADC系数，E1和E2的术后DTI指数保持不变或不显着（P=0.05）ABSTRACTConclusion. The DTI indices were sensitive enough toindicate postoperativ

59、e neurological recovery observedfollowingsurgery.PreoperativeDTIevaluationcouldnotpredictpostoperativerecoveryforpatientswithcervicalspondyloticmyelopathy.结论：DTI指数足够敏感预测手术后观察到神经恢复。术前DTI评估无法预测髓性颈椎病患者的术后恢复。* Postoperative DTI indices were sensitive to differentiate postoperative clinicaloutcome follow

60、ing surgery, showing comparable change with recovery and nosignificantchangewasseeninpatientswhoshowednorecoveryorworsenedaftersurgery.*StatisticallysignificantimprovementwasnotedinDTIindicesvaluesforADC,Eigenvectors E1 and E2 at 12 months following surgery in the patients showingneurologicalrecover

61、y.* Though postoperative MRI showed satisfactory decompression in all surgicallytreatedpatientspostoperativeDTIindicesshowedvariableresults.* Preoperative DTI could not predict which patient would show clinical recoveryfollowingsurgicaldecompression.*术后DTI指数对手术后的临床结果敏感，显示与恢复相当的变化，在手术后未恢复或恶化的患者中未见显着变

62、化。*在显示神经恢复的患者中，在手术后12个月的ADC，特征向量E1和E2的DTI指数值中观察到统计学显着的改善。*虽然术后MRI显示所有手术治疗患者的减压良好，术后DTI指数显示可变的结果。*术前DTI无法预测患者在手术减压后的临床恢复磁共振弥散张量成像（diffusiontensorimaging,DTI）实现活体观察组织结构的完整性和连通性，利于对各种疾病的引起的白质纤维束的损害程度及范围的判断。可用于显示脑白质内神经传导束的走行方向，实现对人的中枢神经纤维精细成像。MR图像的信号：组织T1、T2驰豫时间、H1的密度、分子弥散运动DTI的基本原理：利用扩散敏感梯度脉冲将水分子弥散效应扩大

63、，来研究不同组织中水分子扩散运动的差异（扩散加权相DWI）。DTI可利用扩散敏感梯度从多个方向对水分子的扩散各向异性进行量化，因此有可能反映组织内的细微结构及病理生理改变。扩散张量成像(difusion tensor imaging，DTI)可以观察脊髓病变及再生修复的动态过程，进行组织微观结构改变的定量分析，纤维束示踪成像技术可以立体展现白质纤维束的形态表观扩散系数(apparentdifusioncoefficient，DCADC值越大，说明水分子的弥散能力越强；三个互相垂直方向的ADC值的平均数是平均扩散率(meandisivity，MD)，它不受方向影响；各向异性包括部分各向异性(fr

64、actionanisotropy，FA)和相对各向异性(relativeanisotropy，RA)FA、RA都是非矢量值(数值，无方向性)，取值范围为是01既组织结构排列越规律紧密，组织的各向异性越强，各向异性系数越大张量方向由于弥散张量具有方向性，可以从弥散张量所含信息中显示出纤维方向的图，利用纤维束示踪成像技术，立体展现白质纤维束的形态TheAssessmentofNeuronalStatusinNormalandCervicalSpondyloticMyelopathyUsingDiffusionTensorImaging弥散张量成像在正常和脊髓型颈椎病对神经元的状态的评价STUDY

65、DESIGN: A prospective observational analysis ofdiffusion tensor imaging (DTI) datametrics collected fromcontrol and patients with cervical spondylotic myelopathy(CSM).研究设计：收集脊髓型颈椎病（CSM）的弥散张量成像（DTI）数据前瞻性观察分析。AbstractOBJECTIVE:TheaimsweretostudytheuseofDTIinCSM and to probe whether DTI datametrics and

66、tractography will correlate with magnetic resonanceimagingandclinicalfindings.目的：目的是研究在CSM患者中使用DTI和探讨DTI跟踪技术磁共振成像和临床表现相关。AbstractSUMMARYOFBACKGROUNDDATA:MagneticresonanceimagingisthecurrentgoldstandardintheassessmentofcordstatusinCSM;however,variousparameterssuchasextent of compression and presence

67、of signal intensitychangesdonotcorrelatewellwithclinicalstatus.DTIisanovel investigation tool with proven applications in brainpathologies but is not routinely used in spinal cordevaluation.背景资料概述：磁共振成像是在目前CSM状况评估的“金标准”;然而，各种参数与临床情况相关性不是很好。DTI是一种新型的检测方式，常用在颅脑的诊断中，但在脊柱脊髓的诊断中不常使用。AbstractMETHODS: Pati

68、ents with CSM (n = 35) who required surgicaldecompression(meanage=48yr)and40normalindividuals(meanage=38yr)wereincluded.DiffusionTensorImagingofthecervicalspinewas obtained using a 1.5T magnetic resonance image. Apparentdiffusioncoefficient,fractionalanisotropy,andeigenvalues(E1,E2,andE3)wereobtaine

69、dateachcervicallevel.TheDTIdatametricsofCSMpatients were compared with normal volunteers and correlated withindividual and grouped Nurick grades, which indicate the neurologicalstatusofpatients.方法：35名需要手术减压的CSM患者（平均年龄=48岁）和40名正常人（平均年龄=38岁）纳入研究。颈椎的弥散张量成像是使用1.5T磁共振图像获得。获取每个节段的表观扩散系数，分数各向异性，和特征值（E1，E2和

70、E3）的数据。CSM患者的DTIdatametrics与正常人进行了比较，并和Nurick等级关联起来。AbstractRESULTS:TherewassignificantdifferenceinDTIdatametricsbetweenpatients with myelopathy and control (P 0.05), with decrease infractional anisotropy (0.49 0.081 vs. 0.53 0.07) and increase inapparent diffusion coefficient (1.8 0.315 vs. 1.44 0.

71、145) andeigenvalues(E1:2.820.395vs.2.370.221,E2:1.640.39vs.1.180.198,E3:0.9560.277vs.0.760.142).Therewasalsoasignificantdifference between increasing grades of myelopathy when individualswere grouped as-control, self-ambulant (Nurick grades 1 and 2), anddependent(Nurickgrades3,4,and5).结果：在CMS和对照组中DT

72、Idatametrics存在显著差异（P0.05），各向异性分数降低（0.490.081与0.530.07），表观扩散系数（1.80.315与1.440.145）和特征值增加（E1：2.820.395与2.370.221，E2：1.640.391.18与0.198，E3：0.9560.277与0.760.142）。根据Nurick等级得分的不同，脊髓的MRIDTI也不同。1.Tractographypatterns:(A)normal,(B)waisting,(C)partially interrupted, and (D) completely interrupted.Arrowsshowc

73、ompressedregions.AbstractCONCLUSION: The study shows that DTI is a promising and usefulinvestigationaltoolinevaluationofCSM.TherewasasignificantdifferenceinallDTIvaluesbetweencontrolandpatientswithCSM,andtherewasasignificanttrendofchangeinvaluesbetweencontrol,self-ambulant,anddependent patients. Our

74、 results encourage further investigation of thisimportantmodality.结论：该研究表明，DTI是评价CSM的一个有前途的和有用的研究性的工具。对照组和CMS组的DTI数值是显著不同的，并且与Nurick等级得分有关系。我们的研究结果指导下一步的继续研究。TITLERoutineUseofIntraoperativeNeuromonitoringDuringACDFsfortheTreatmentofSpondyloticMyelopathyandRadiculopathyIsQuestionable:AReviewof15,395C

75、asesUCLAMedicalCenter,DepartmentofOrthopaedicSurgery,LosAngeles,CA在ACDF治疗髓性或根性颈椎病术中常规使用神经监护是可疑的：回顾15,395例StudyDesign.Aretrospectivedatabasestudy.研究设计：回顾性数据库研究。ABSTRACTObjective.Thegoalofthisstudywasto(1)evaluatethetrendsintheuseofintraoperativeneuromonitoring(ION)for anterior cervical discectomy and

76、 fusion (ACDF)surgery in the United States and (2) assess theincidenceofneurologicalinjuriesafterACDFswithandwithoutION.目的：本研究的目的是（1）评估在美国使用术中神经监护（ION）用于前颈椎间盘切除术和融合（ACDF）手术的趋势，以及（2）评估ACDF后神经损伤的发生率有和没有ION。ABSTRACTSummary of Background Data. Somatosensory-evoked potentials(SSEPs) and motor-evoked pote

77、ntials (MEPs) are the commonlyusedIONmodalitiesforACDFs.Controversyexistsontheroutineuse of ION for ACDFs and there is limited literature on nationalpracticepatternsofitsuse.背景数据的概述：体感诱发电位（SSEP）和运动诱发电位（MEP）是ACDF常用的ION方式。关于ION用于ACDF的常规使用存在争议，并且关于其使用的国家实践模式的文献有限。ABSTRACTMethods：Aretrospectivereviewwas

78、performedusingthePearlDiverPatientRecordDatabasetoidentifycasesof spondylotic myelopathy and radiculopathy thatunderwentACDFfrom2007to2014.ThetypeofIONmodalityusedandtheratesofneurologicalinjuryaftersurgerywereassessed.方法：使用PearlDiver患者记录数据库进行回顾性评估，以确定2007年至2014年期间接受ACDF的髓性颈椎病和根性颈椎病的病例。评估使用ION方式类型和手

79、术后神经损伤的发生率。pearldiver已经建立了一个世界上最大的医疗保健数据库超过40亿符合HIPAA病人记录。在这个基础上，pearldiver能够提供医院、医务人员、医疗设备公司高管、分析师和监管机构的关键见解和可操作的信息。PearlDiverhaspartneredwithComprehensiveHealthInsightstointegrateHumanas（医疗保险巨头） full claims database in to the PearlDiverresearchprogram.AsofJuly,2016Humanarepresents20.9millionpatien

80、tsthroughouttheduration of the set including claims from 2007 through Q3 2015. Nosamplingisperformedonthisdata.Researchisconductedoverthefullsetincluding commercial and Medicare advantage populations. While de-identified and HIPAA compliant, this research set is fully capable oflongitudinalresearchb

81、aseduponuniquepatientidentifiercodes.ResearchcanbeperformedutilizinganyoneorcombinationofidentifiablefieldsontheclaimrecordprocessedbyHumana.Fieldsincludebutarenotlimitedto;ICD-9&ICD-10diagnosiscoding,DRGproceduralcoding,ICD-9& ICD-10 procedural coding, CPT procedural coding, prescription NDCcoding,

82、labrecordLOINCcoding,dischargestatus,demographic,physicianspecialty,andgeographicregionorstate.DETAILSScope:NationalTimePeriod:2007Q32015TotalPatientVolume:20.9millionLongitudinal:Yes,timespecificcapableProviders:Facility,physician,ancillaryservices,pharmacyGeographicInclusion:AllU.S.statesandterrit

83、oriesResearchableprocedure/drug/labcoding:DRG,ICD-9Diagnosis,ICD-10Diagnosis,ICD-9procedural,ICD-10procedural,CPT,NDC,LOINCAdditionalfilters:Age,date,dischargestatus,druggroup,fieldnumber(primary,secondary,tertiary,etc.),gender,lengthofstay,physicianspecialty,plantype,race,region,servicelocation,and

84、statePayerTypes:Individualcommercial,state-basedMedicaid,MedicarestandalonePDP,groupMedicareAdvantage,andIndividualMedicareAdvantageModifiersincluded:YesCostofCareAvailability:InsurerreimbursedamountperclaimUpdates:DataisupdatedonaquarterlybasisABSTRACTResults.Duringthestudyperiod,15,395patientsunde

85、rwentanACDF.Overall,IONwasusedin2627(17.1%)ofthesecases.TherewasadecreaseintheuseofIONforACDFsfrom22.8%in2007to4.3%usein2014(P0.0001).TheIONmodalitiesusedfortheseACDFswerequitevariable:SSEPsonly(48.7%),MMEPsonly(5.3%),andcombinedSSEPsandMMEPs(46.1%).Neurologicalinjuriesoccurredin0.23%and0.27%ofpatie

86、ntswithandwithoutION,respectively(P=0.84).YoungeragewasassociatedwithahigherutilityofION(75:13.6%,P0.0001).SignificantregionalvariabilitywasobservedintheutilityofIONforACDFsacrossthecountry(West;21.9%,Midwest;12.9%(P0.0001).结果：在研究期间，15,395例患者接受ACDF。总体而言，ION用于2627例（17.1）的病例。ACDF的ION的使用从2007年的22.8下降到2

87、014年的4.3（P0.0001）。用于这些ACDF的ION模态是相当可变的：仅SSEP（48.7），仅MMEP（5.3），以及SSEP和MMEP组合（46.1）。有和无ION患者神经损伤发生分别为0.23和0.27（P=0.84）。年轻与ION的更高效用相关（75：13.6，P0.0001）。观察到ION对全国ACDF的效用具有显着的区域变异性（西;21.9，中西部;12.9（P0.0001）。ABSTRACTConclusion.TherehasbeenasignificantdecreaseintheuseofIONfor ACDFs. Furthermore, there was si

88、gnificant age and regionalvariabilityintheuseofIONforACDFs.UseofIONdoesnotfurtherprevent the rate of postoperative neurological complications forACDFs as compared with the cases without ION. The utility ofroutineIONforACDFsisquestionable.结论：ION用于ACDF的使用显着减少。此外，使用ION用于ACDF存在显着的年龄和区域变异性。与没有ION的情况相比，IO

89、N的使用不进一步防止ACDF的术后神经学并发症的发生率。常规ION对ACDF的效用是值得怀疑的。*Controversyexistsintheutilityofroutineuseofintraoperativeneuromonitoring(ION)foranteriorcervicaldiscectomyandfusion(ACDF)fordegenerativeconditionswithoutdeformity.*Onanationallevel,therehasbeenasignificantdecreaseintheuseofIONforACDF.*Theoverallriskof

90、neurologicalcomplicationsafterACDFislow(1%).*TheuseofIONdidnotfurtherpreventpostoperativeneurologicalcomplicationsforACDFsascomparedwiththecaseswithoutION.*TheutilityofroutineIONforACDFsisquestionable.对于在没有畸形的前路颈椎间盘切除和融合术（ACDF）常规使用术中神经监护（ION）是有争议的。*在全国范围统计，ACDF术中使用ION逐渐减少。*ACDF后神经系统并发症的总体风险低（ 4 mm o

91、f motion and/or 10 of angulationbetweenflexion/extensionradiographs).在退行性脊椎滑脱（DS）的治疗时进行融合的理论基本上基于25年前进行的研究。最近，发表了两项大规模随机试验，研究DS患者是否应该接受减压或融合治疗。两个研究发现两组之间的临床结果没有什么区别，尽管他们的结论没有明确区分“稳定”和“不稳定”滑脱。DS不应与不稳混淆（4mm运动和/或屈曲/伸展X线片10）。Point of ViewAlmost all of the patients in both studies were treated with a mid

92、linelaminectomy. The concern with a laminectomy is violation of stabilizinginter/supraspinousligaments.Theevolutionoflessinvasivedecompressivetechniques has obviated fusion in select patients, as 53% of surgeonswould recommend a decompression alone for a properly selected DSpatient.在两项研究中几乎所有的患者都用中线

93、椎板切除术治疗。对椎板切除应注意对椎间/上棘韧带的侵犯。较小侵入性减压技术的发展已经避免了选择融合，因为53的外科医生推荐单纯减压用于适当选择的DS患者。Point of ViewThis study is a case series of patients treated by a less invasivedecompressionversusfusion. The authors indications changed over thestudyperiod;ofparticularinterestarethe45patientsinthelategroupwith“unstable”

94、slips ( 5 mm of dynamic translation and 10 of rotation).Although slip progression was seen in 37% of levels, there were nodifferencesinclinicaloutcomebetweenthetwogroups.Itshouldbenotedthatpatientswithadecompressionaloneweresignificantlyolderandhadshorterfollowupthanthefusiongroup.这项研究是一个较少侵入性减压与融合的

95、病例系列。在研究期间，作者的适应症改变了;特别是在晚期组中具有“不稳定”滑移（5mm的动态平移和10的旋转）的45位患者。虽然在37的水平出现滑移进展，但两组之间的临床结果没有差异。应当注意，单纯减压的患者岁数较大，并且比融合组随访更短。Point of ViewTheseoutstandingstudiesemphasizetheimportanceofdifferentiatingbetween“stable”and“unstable”slips.Inaddition,patientswithDSoftenhave coexisting degenerative discs, forami

96、nal stenosis, and coronalimbalancethatmaynecessitatefusion.Itiscriticalthateachpatientistreatedindividuallywithanunderstandingthatadecompressionalonecanyieldexcellentresultsinselectpatients.这些杰出的研究强调区分“稳定”和“不稳定”滑移的重要性。此外，DS患者常常具有共存的退行性椎间盘，椎间孔狭窄和冠状不平衡，这可能需要融合。关键的是，每个患者的个体化治疗，所以单纯减压产生了优异的结果。TitleDiscr

97、epancy Between Standing Posture and SagittalBalance During Walking in Adult Spinal DeformityPatients成年脊柱畸形患者行走和站立姿势矢状平衡之间的差异DepartmentofOrthopaedicSurgery,HamamatsuUniversitySchoolofMedicine,Shizuoka,JapanStudyDesign.Retrospectivecaseseries.研究设计：回顾性病例系列。ABSTRACTObjective. The present study aimed tod

98、etermine the characteristics of patientswith adult spinal deformity (ASD) with adiscrepancybetweenstandingandwalkingpostures.目的：本研究旨在确定成年脊柱畸形（ASD）患者的站立和行走姿势之间的差异的特点。ABSTRACTSummary of Background Data. Standing radiographicparametersaretypicallyusedtoevaluatepatientswithASD. Patients with ASD with re

99、latively good sagittalalignmentonstandingradiographyhave,however,beenreportedtowalkwithaforwardtrunktilt.背景数据总结：常规放射参数通常用于评估ASD患者。然而，据报道，在常规放射中具有相对良好矢状位对齐的ASD的患者以前倾的姿势行走。ABSTRACTMethods.PatientswithASD(n=93;13men,80women;meanage,65.0yr)whounderwentcorrectivesurgeryandpreoperativegaitanalysisatourhos

100、pitalbetween2011and2013wereincluded.Spineradiographsandgaitanalysisdatawereacquiredpreoperatively.Standing-trunktiltangle(STA)onlateralstandingx-ray,gait-trunktiltangle(GTA)fromlateralgaitimages,andradiographicparametersofthespineandpelvis(lumbarlordosisLL,pelvic tilt, and sagittal vertical axis) we

101、re measured. We calculated theincreasingtrunktiltangle(ITA),bysubtractingtheSTAfromtheGTA,foruse as an index of discrepancy between standing posture and sagittalbalance during walking. We examined the relation between radiographicparametersandITA.方法：纳入2011年至2013年在我院接受矫正手术和术前步态分析的ASD患者（n=93;13男性，80女性

102、，平均年龄65.0岁）。手术前获取脊柱X光片和步态分析数据站立X射线：站立躯干倾斜角（STA），来自步态图像的步态躯干倾斜角（GTA），以及脊柱和骨盆的参数（腰椎前凸LL，盆腔倾斜和矢状垂直轴）。我们通过从GTA中减去STA，计算增加的躯干倾斜角（ITA），用作行走时站立姿势和矢状平衡之间的差异的指标。我们检查了射线参数和ITA之间的关系。ABSTRACTResults. The mean preoperative STA and GTA were 3.5 and 11.1,respectively. ThemeanpreoperativeITA,whichrepresentsthedegre

103、eofdiscrepancybetweenstandingpostureandsagittalbalanceduringwalking,was7.6.Themeanpreoperativesagittalverticalaxis,LL,pelvicincidence(PI),pelvictilt,andPIminusLLwere102.6mm,20.3,52.9,32.1,and32.6,respectively.ThePIminusLLmismatchwaspositivelycorrelatedwiththeITA(R=0.237,P=0.023).Inparticular,patient

104、swithASDwithaPIminusLLmismatchofmorethan40hadasignificantlygreaterITA.结果：平均术前STA和GTA分别为3.5和11.1。平均术前ITA，表示站立姿势和步行的矢状平衡之间的差异程度，为7.6。平均术前矢状垂直轴LL，盆腔入射（PI），盆腔倾斜和PI减去LL分别为102.6mm，20.3，52.9，32.1和32.6。PI减LL与ITA正相关（R=0.237，P=0.023）。具有大于40的PI减去LL的ASD的患者具有显着更大的ITA。ABSTRACTConclusion.Gaitanalysisrevealedthatap

105、reoperativestanding-walkingdiscrepancyis associated with severe PI - LLmismatch.结论：步态分析显示，术前站立走差与严重的PI-LL不匹配有关。ABSTRACT* The present study investigated the characteristics ofpatientswithASDwithadiscrepancybetweenstandingand walking postures. * Compared with the standingcondition, the trunk is tilted

106、 forward by an average ofapproximately8inthewalkingconditioninpatientswithASDpreoperatively.*Thepresentstudyrevealedthatapreoperativestanding-walkingdiscrepancyisassociatedwithseverePI-LLmismatch.*本研究调查了ASD患者的站立和行走姿势之间的差异的特点。*与站立状态相比，在术前ASD患者的行走状态下，躯干向前倾斜约8。*本研究显示，术前站立走路差异与严重的PI-LL不匹配有关。TITLEFunctio

107、n and Clinical Symptoms are the Main FactorsthatMotivateThoracolumbarAdultScoliosisPatientstoPursueSurgery功能和临床症状是促使成人胸腰椎脊柱侧凸患者进行手术的主要因素SpineUnit,DepartmentofOrthopedicSurgery,HospitalUniversitarioLaPaz,Madrid,SpainStudy Design. A retrospective two-cohort comparativeanalysis of data collected prospe

108、ctively in an adultdeformitymulticenterdatabase.研究设计：回顾性比较分析在成人畸形多中心数据库前瞻性收集的两队列数据。ABSTRACTObjective. The aim of this study was todefinetheradiographicandclinicalparametersthatmotivateadultthoracolumbar (TL) scoliosis patients toundergosurgery.目的：本研究的目的是确定影响成人胸腰段（TL）脊柱侧弯患者进行手术的放射学和临床参数。ABSTRACTSumma

109、ryofBackgroundData.TLcurvesareaprimaryconcerninadulthood,anditisnecessarytoestablishwhypatientsaremotivatedtoseeksurgicalintervention.背景数据的总结：TL曲线是成年人的主要关注点，并且有必要确定患者有什么动机寻求手术干预。ABSTRACTMethods.PatientswithonlymainTL/lumbar(TL/L)idiopathiccurveswereincluded,definedasSchwabtypeLcurvesandSchwabtypeD c

110、urves in which thoracic curves were =15.Demographicdata,health-related quality of life (HRQOL) questionnaires, and 14 differentradiologicalpreoperativeparameterswereassessed.Surgicalversusconservative cohorts were compared with theStudentttest,Chi-square,andtheMann-WhitneyUtest.方法：包括（TL/L）特发性的患者，定义为

111、SchwabL型和SchwabD型，其中胸廓曲线=15。收集人口统计数据，健康相关生活质量（HRQOL）调查问卷和14个不同的放射性术前参数。将外科与保守组进行Studentt检验，卡方检验和Mann-WhitneyU检验进行比较。ABSTRACTResults.Atotalof184patientsmettheinclusioncriteria.Ninety-fourweretreatedconservatively(C),while90underwent surgery (S). No differences were found between groups in terms of de

112、mographic or radiographicpreoperativedata.Age(C:57.518vs.S:54.218yr;P=0.18),coronalTL/LCobb(C:52.315vs.S:50.613;P= 0.61), andsagittalalignment(SVA C: 3.1 cm 5.7vs. S: 4.9 cm 6.4;P= 0.054)weresimilar. Nodifferenceswerefoundinpelvicparameters(pelvicincidence,pelvictilt,sacralslope),apicaltranslation,c

113、oronalbalance,lumbarrotatorysubluxation,orlumbarlordosis.However,significantdifferenceswerefoundinHRQOLquestionnaires.SurgicalpatientsinitiallyhadworseCOMIscores(C:4.62.3vs.S:62.3;P=0.001),worseODIscores(C:27.716vs.S:38.920;P=0.000),worseSF-36physical(C:40.98.5vs.S:369.5;P=0.001)andmentalscores(C:45

114、.812vs.S:42.211.8;P=0.032),andworseSRS-22scoresinalldomainswithmeanvaluesunder3.1points(range=2.43.1).InbothSF-36physicalandSRS-22function,differencesbetweengroupswerehigherthantheminimumclinicallyimportantdifference.结果：共有184名患者符合入选标准。保守治疗组（C）94，手术组（S）90。在人群或术前放射数据方面没有发现组间差异。年龄（C：57.518、S：54.218岁;P=

115、0.18），冠状TL/LCobb（C：52.315、S：50.613;P=0.61）（SVAC：3.1cm5.7、S：4.9cm6.4;P=0.054）相似。在盆腔参数（PI，PT，SS），顶锥平移，冠状平衡，腰椎旋转半脱位或腰椎前凸没有差异。然而，在HRQOL问卷中发现显着差异。手术患者最初具有较差的COMI评分（C：4.62.3、S：62.3;P=0.001），更差的ODI评分（C：27.716、S：38.920;P=0.000）SF-36（C：40.98.5、S：369.5;P=0.001）和心理分数（C：45.812、S：42.211.8;P=0.032）。在SF-36物理和SRS-2

116、2功能中，组之间的差异高于最小临床重要差异。ABSTRACTConclusion.Afteranalyzingalargemulticenterdatabase,wefoundthatonlyclinicalfactorsparticularlyfunctionimpairmentmotivated adult TL scoliosis patients toundergosurgery.Demographicandradiographicparametersdidnotseemtoinfluencedecision-making.结论：分析大型多中心数据库后，我们发现只有临床因素，特别是功能

117、障碍导致成年TL脊柱侧弯患者接受手术。人口统计和放射参数似乎不影响决策。*Thereiscontroversyregardingwhenathoracolumbaradultscoliosispatientshouldundergosurgery,andwhytheyaremotivatedtodoso.*Atotalof184patientswiththoracolumbar/lumbarscoliosiswereincludedfromaninternationalmulticenteradultdeformityprospectivedatabase.*Comparingsurgical

118、patientswithconservativelytreatedpatients,wefoundthatneitherdemographicnorradiographicparametersinfluenceddecision-makingaboutsurgery.*Clinicalsymptoms,particularlyfunctionimpairment,motivatedpatientstoundergosurgery.*对于一个成年胸腰椎脊柱侧凸患者接受手术的动机存在争议。*从国际多中心成人畸形前瞻性数据库中选取总共184名胸腰椎/腰椎侧凸的患者。*比较手术患者和保守治疗的患者，我

119、们发现人口统计学和影像参数均不影响关于手术的决策。*有临床症状，特别是功能障碍的患者接受手术。TITLEFrequency and Risk Factors for AdditionalLesions in the Axial Spine in Subjects WithChordoma:IndicationsforScreeningMusculoskeletalRadiology,DepartmentofRadiology,PerelmanSchoolofMedicine,UniversityofPennsylvania,Philadelphia,PA脊柱脊索瘤患者脊柱轴向其他病变的频率和危

120、险因素StudyDesign.Retrospectivecohortstudy.研究设计：回顾性队列研究。ABSTRACTObjective.Weaimtoevaluatethefrequency and clinical significance ofadditional lesions in the axial spine insubjectswithchordomaandtoassesstheneedforscreening.目的：我们的目标是评估脊索瘤患者轴向脊柱中额外病变的频率和临床意义，并评估筛查的需要。ABSTRACTSummaryofBackgroundData.Chordom

121、asareraretumorsthatmaybemulticentricormetastasizeandaffectseveralbonesintheaxialspine. The incidence of multiple lesions in the axial spine isunknown.Understandingtheincidencerateofmultiplelesionsinthespineinsubjectswithchordomaswillhelpguideutilizationoftotalspinescreeningimaging.背景资料：脊索瘤是罕见的肿瘤，可能多

122、中心或转移并影响轴向脊柱中的几个骨骼。轴向多发性损害的发生率是未知的。了解脊柱肿瘤患者脊柱中多发性损害的发生率将有助于指导整个脊柱筛查成像的利用ABSTRACTMethods. We performed a retrospective review of medical records of 42subjects with histologically confirmed chordomas who had completeimagingoftheaxialspine.Lesionswithimagingcharacteristicssuggestiveof chordomas/notocho

123、rdal remnants were identified. Data on age atdiagnosis, sex, size (in maximal dimension), type of chordoma(conventional, chondroid, or dedifferentiated), and whether pulmonarymetastases were present were recorded. Binomial two-sample tests ofproportions were used to compare proportions. Logistic reg

124、ression wasusedtoassesspredictorsofadditionallesions.方法：我们对组织病理学确认为脊髓瘤的42名受试者的医疗记录进行了回顾性研究，这些患者具有轴向脊柱的完整成像。鉴定了具有提示脊索瘤/脊索残余的成像特征的损伤。记录诊断年龄，性别，大小（最大尺寸），脊索瘤类型（普通，软骨样或间质型）和是否存在肺转移的数据。使用比例的二项式双样本测试来比较比例。Logistic回归用于评估额外病变的预测因子。ABSTRACTResults：Forty-two subjects (57.1% male) were identified. Theproportion

125、ofsubjectswithadditionallesionsintheaxialspinewas16.7%(7/42).Age,sex,size,andsubtypeofchordomawerenotsignificantpredictorsofhavingadditionallesions(P0.05foreachvariable).However,havingpulmonarymetastaseswasasignificantpredictorofhavingadditionallesions(P0.05）。然而，肺转移是额外病变的重要预测因素（P0.05）。ABSTRACTConclu

126、sion. Approximately 17% of subjects with chordomas hadadditional lesions in the axial spine. It is unclear whether theserepresentmetastases,synchronousprimarychordomasornotochordal remnanttissue. Screening imaging of the axial spinemayrevealadditionallesionsinparticularinsubjectswithpulmonarymetasta

127、ses.结论：大约17的具有脊索瘤的受试者在轴向脊柱中具有另外的病变。尚不清楚这些是否代表转移，同步原发性脊索瘤或脊索残留组织。轴向脊柱的筛查成像可以提示额外的病变，特别是在有肺转移的受试者中。*Approximately17%ofsubjectsinourcohortwithchordomaswithtotalaxialspineimaginghadadditionallesionsinthespine.* Seventy-one percent of subjects with additional lesions in thespinehadpulmonarymetastases.*Sc

128、reeningimagingoftheentireaxialspinemayrevealadditionallesionsinparticularinsubjectswithpulmonarymetastases.*我们的队列中约17的受试者在脊柱中具有额外的病变。*71在脊柱中有额外病变的受试者有肺转移。*整个轴向脊柱的筛查成像可以发现额外的病变，特别是在具有肺转移的受试者中。TITLETheInfluenceofRaceonShort-termOutcomesAfterLaminectomyand/orFusionSpineSurgery种族对椎板切除和/或融合脊柱手术后短期结果的影响De

129、partmentofPsychiatry,UniversityofIllinoisatChicago,Chicago,ILStudyDesign.Aretrospectivecohortanalysisofprospectivelycollectedclinicaldata.研究设计：前瞻性收集的临床数据的回顾性队列分析。ABSTRACTObjective. The aim of this study was toassesstheeffectofraceonoutcomesinpatients undergoing elective laminectomyand/orfusionspines

130、urgery.目的：本研究的目的是评估种族对接受选择性椎板切除术和/或融合脊柱手术的患者的结果的影响。ABSTRACTSummary of Background Data. Studiesthathavelookedattheeffectofraceonspine surgery outcomes have failed totakeintoaccountbaselineriskfactorsthatmayinfluenceperi-operativeoutcomes.背景：研究可能影响围手术期结果的基线风险因素未能考虑种族。ABSTRACTMethods.Weidentified48,493

131、adultpatientswhounderwentelectivespinesurgeryconsistingofelectivelaminectomyand/orfusion,from2006to2012,athospitalsparticipatingintheAmericanCollege of Surgeons National Surgical Quality Improvement Program (ACS NSQIP), aprospectivelycollected,nationalclinicaldatabasewithestablishedreproducibilityan

132、dvalidity.Pre-and intraoperative characteristics and 30-day outcomes were stratified by race. We usedpropensity scores to match African-American and Caucasian patients on all pre- andintraoperative factors, including by principal diagnosis leading to surgery as well as surgeryperformed.Weusedregular

133、andconditionallogisticregressiontopredicttheeffectofraceonadversepostoperativeoutcomesinthefullsampleandmatchedsample.方法：2006年至2012年，参加美国外科医师国家外科质量改进计划（ACSNSQIP）的医院确定了48493名接受了选择性脊柱手术的成人患者，包括选择性椎板切除术和/或融合术，这是一个前瞻性收集的国家临床数据库的研究具有确定的可重复性和有效性。术前和术中特征和30天结果按种族分层。我们使用倾向得分来匹配非裔美国人和白种人患者的所有术前和术中因素，包括通过主要诊断

134、。我们使用常规和条件logistic回归预测种族对全部样本和匹配样本中不良术后结果的影响。ABSTRACTResults.Caucasianscomprised82%ofoursample.Wefoundnodifferencesintheincidenceofpre-andintraoperativefactorswhencomparingCaucasianpatientswithallminoritypatients,andonlyminimalincreasedoddsforprolongedlengthoflengthof hospitalization (LOS) and disch

135、arge with continued care. However, African-American patients, who comprised 39% of our minority sample, had morepreoperative comorbidities than Caucasian patients. Even after eliminating alldifferencesbetweenpre-andintraoperativefactorsbetweenCaucasianandAfrican-Americanpatients,African-Americanpati

136、entscontinuedtohaveLOSthatwas,onaverage,onedaylongerthanCaucasianpatients.African-Americanpatientsalsohadhigheroddsformajorcomplicationsoddsratio(OR)=1.3;95%confidenceinterval(95%CI)1.11.6,andtobedischargedrequiringcontinuedcare(OR=2.3;95%CI1.82.8).结果：白种人占我们样本的82。我们发现，当比较白种人患者与所有少数民族患者时，术前和术中因素的发生率没

137、有差异，只有长期住院时间（LOS）和持续护理增加几率。然而，我们的少数民族样本中39的非裔美国人患者具有比高加索人更多的术前合并症。即使在消除了白种人和非裔美国人患者之间和术中因素之间的所有差异之后，非裔美国人患者的LOS平均比高加索人的平均时间延长一天。非裔美国人患者的主要并发症的几率更高比值比（OR）=1.3;95置信区间（95CI）1.1-1.6，并且需要继续护理（OR=2.3;95CI1.8-2.8）。ABSTRACTConclusion.African-Americanraceisindependently associated with prolongedLOS,majorcomp

138、lications,andaneedtobe discharged with continued care inpatientsundergoingelectivespinesurgery.结论：非裔美国人种族与长期LOS，主要并发症独立相关，并且在进行选择性脊柱手术的患者中需要继续护理。*Althoughsomestudieshaveassessedoutcomesinsubpopulationsofpatientswhoundergospinesurgery,therehasbeenlimitedconsensusoftheeffectofraceonoutcomes.*Usingapro

139、spectivelycollecteddatabasefromnearly400institutions,weassessedtheeffectofraceonoutcomesof48,493patientsundergoingelectivelaminectomy,fusion,orboth.*African-AmericanraceisindependentlyassociatedwithprolongedLOS,majorcomplications,andaneedtobedischargedwithcontinuedcareinpatientsundergoingelectivespi

140、nesurgery.*IncreasedawarenesstotheadverseeffectofAfrican-Americanraceonoutcomescanalertsurgeonsandotherclinicianstoaggressivelyoptimizethesepatientsmedicallybeforesurgery.*虽然一些研究已经评估了接受脊柱手术的患者亚组的结果，但是对种族对结果的影响的认识是有限。*使用来自近400个机构的前瞻性收集的数据库，我们评估了种族对48,493例接受选择性椎板切除和或融合患者的结果的影响。*非裔美国人种族与长期LOS，主要并发症独立相关

141、，并且需要在进行选择性脊柱手术后进行出院后持续护理。*提高对非裔美国人种族手术结果的不良影响的认识可以提醒外科医生和其他临床医生在手术前积极对待这些患者。TITLEA Systematic Review of the Soft-Tissue ConnectionsBetweenNeckMusclesandDuraMater:TheMyoduralBridge连接颈部肌肉和硬脑膜之间的软组织的系统评价：肌肉桥DepartmentofPhysicalTherapy,OccupationalTherapy,Rehabilitation and Physical Medicine, Universid

142、ad ReyJuanCarlos,Alcorcn,Madrid,SpainStudyDesign.Systematicreview.研究设计：系统回顾ABSTRACTObjective.Toelucidatetheexistenceofsofttissueconnectionsbetweentheneckmusclesandcervicalduramater.目的：阐明颈部肌肉和颈部硬脑膜之间软组织连接的存在。ABSTRACTSummary of Background Data. Severalstudiesdiscusstheexistenceofacervicalmyoduralbridg

143、e;however,conflictingdatahavebeenreported.背景资料摘要：有几项研究讨论了颈部肌筋膜桥的存在;然而，也有文章报告了相反的数据。ABSTRACTMethods. Searches were conducted in the PubMed, Web of Science,Cochrane Library, and PEDro databases. Studies reporting original dataregarding the continuity of nonpost-surgical soft tissue between thecervical

144、 muscles and dura mater were reviewed. Two reviewersindependently selected articles, and a third one resolved disagreements.Another two researchers extracted the methodology of the study, theanatomicalfindings,andevaluatedthequalityofthestudiesusingQualityAppraisalforCadavericStudiesScale.Adifferent

145、thirdresearcherresolveddisagreements.方法：在PubMed，WebofScience，Cochrane图书馆和PEDro数据库中进行搜索。回顾了关于颈部肌肉和硬脑膜之间的非手术后软组织的连续性的原始数据的研究。两个评审员独立选择文章，第三个评审员解决分歧。另两位研究人员提供了研究的方法，解剖结果，并使用质量评价的尸体研究量表评估研究的质量。不同的第三研究者解决分歧。ABSTRACTResults. Twenty-six studies were included. A soft tissue connection between therectus capi

146、tis posterior minor, the rectus capitis posterior major, and the obliquuscapitisinferiormusclesseemstobeprovedwithastronglevelofevidenceforeachoneofthem.Controversyexistsaboutthepossiblecommunicationbetweentheduramaterandtheuppertrapezius,rhomboideusminor,serratusposteriorsuperior,andspleniuscapitis

147、bymeansoftheligamentumnuchae.Finally,thereislimitedevidenceabouttheexistenceofasofttissueconnectionbetweenrectuscapitisanteriormuscleandtheduramater.结果：纳入26项研究。有高的证据等级证明头后小直肌、头后大直肌、头下斜肌与硬膜有软组织连接。存在于上斜方肌，小菱形肌，上后锯肌，头夹肌存在争论。最后，只有有限的证据表明头前直肌肌和硬脑膜之间存在软组织连接。ABSTRACTConclusion. There is a continuity of sof

148、ttissue between the cervical musculatureand the cervical dura mater; this mighthavephysiological,pathophysiological,and therapeutic implications, and goingsomewaytoexplainingtheeffectofsometherapiesincraniocervicaldisorders.结论：在颈部肌肉组织和颈部硬膜之间存在软组织链接;这可能有生理，病理生理和治疗影响，并以某种方式解释一些疗法对颅颈部疾病的影响。* This syste

149、matic review provides evidence of the existence of physiological softtissueconnectionsbetweenduramaterandRCPmi,RCPma,andOCImuscles.*ControversyexistsaboutthepossiblecommunicationbetweentheduramaterandtheUT,RM,SPS,andSCbymeansoftheLN.*Thereislimitedevidenceabouttheexistenceofasofttissueconnectionbetw

150、eenRCAmuscleandtheduramater.*Themyoduralbridgemayhaveaphysiologicalrole.* It also might help to explain certain symptoms on subjects suffering fromcraniocervical disorders, and the mechanical and neurophysiological effects ofphysicalinterventionssuchasmassage,exercise,manipulation,orsurgicalsection.

151、*该系统评价提供硬脑膜和RCPmi，RCPma和OCI肌肉之间的生理软组织连接的存在的证据。*硬脑膜与UT，RM，SPS和SC之间通过LN连接存在争论。*有限的证据表明RCA肌肉和硬脑膜之间存在软组织连接。*肌筋膜桥可能有生理作用。*它也可能有助于解释患有颅颈功能障碍的患者的某些症状，以及身体干预（如按摩，运动，操作或手术切片）的机械和神经生理学效应。TITLEComparison of Outcomes of Single-Level Anterior CervicalDiscectomy With Fusion and Single-Level Artificial Cervical Di

152、scReplacementforSingle-LevelCervicalDegenerativeDiscDisease单节段前路颈椎椎间盘切除融合术和单节段颈椎椎间盘置换术对单节段颈椎退行性椎间盘疾病的预后比较Department of Orthopaedics, ESI-PGIMSR Model Hospital, NewDelhi,NewDelhi,IndiaStudy Design. A single-center, prospective comparative study ofprospectivelycollectedoutcomes,withaminimum12monthsfol

153、low-up.研究设计：获得了最少12个月随访的前瞻性收集结果的单中心，对照研究。ABSTRACTObjectives. The primary purpose of the study is toinvestigate the clinical, functional, and radiologicaloutcomesofcervicaltotaldiscreplacement (CTDR)incomparisonwithanteriorcervicaldiscectomyandfusion(ACDF) in the treatment of single-level cervical di

154、scdegenerativedisease,prospectively.目的：本研究的主要目的是调查颈椎全椎间盘置换术（CTDR）与前路颈椎间盘切除融合术（ACDF）在单节段颈椎间盘退行性疾病的治疗中的临床，功能和放射学结国。ABSTRACTSummaryofBackgroundData.CTDRhasrecently been an alternative to ACDF incervical disc degenerative disease topreservethemotionatthetreatedlevel.背景资料总结：CTDR是颈椎间盘退行性疾病中ACDF的替代方案，可以保持治

155、疗水平的运动。ABSTRACTMethods.Thisstudyincluded 34patients,whounderwenteithersingle-levelACDF(n=17)orsingle-levelCTDR(n=17)atC3toC7levelforcervicaldiscdegenerativediseasebetweenJuly2012toApril2014withaminimumof12monthsoffollow-up.方法：本研究纳入34例患者，为2012年7月至2014年4月期间接受单节段ACDF（n=17）或单节段CTDR（n=17）的C3至C7的颈椎间盘退行性疾病

156、患者，均有12个月的随访。ABSTRACTResults.Neckdisabilityindex,visualanalogscale,andneck-armpainscoreshowedsignificantdifferencebetweenthetwogroupsatfinalfollow-upof12months.ModifiedorthopedicassociationscoreandNurickscalealsoshowedtheJapanesesignificantdifferencebetweenthetwogroupsatfinalfollow-upof12months.Odom

157、criteriawerenotstatisticallysignificantbetweenthetwogroupsatfinalfollow-up.Thechangesinoverallcervicalsagittalangle(CSA)weresignificantlydifferentbetweenthetwogroups.Thesegmentalangle(SA)wasmaintainedatasignificantlyhighervalueintheCTDRgroupthanintheACDFgroupduringthefollow-upperiod(P0.05).Therangeo

158、fmotionofthecervicalspineandthetreatedlevelwaswellmaintainedandimprovedintheCTDRgroupascomparedwithACDFgroupandshowedextremelystatisticallysignificantdifferencebetweenthetwogroups.结果：颈部功能残疾指数，视觉模拟量表和颈部手臂疼痛评分在两组最终随访12个月时有显着性差异。改良的日本骨科评分和Nurick量表也显示两组在最终随访12个月时有显着差异。Odom标准在在最终随访时没有显着统计学差异。颈总矢状位角（CSA）的

159、变化在两组之间有显着差异。在随访期间，CTDR组的节段角（SA）维持显着高于ACDF组的值（P0.05）。与ACDF组相比，CTDR组的颈椎运动和治疗节段的活动范围得到很好的维持和改善，两组间差异有统计学意义。ABSTRACTConclusion. CTDR was found to be a safe, effective,better, and efficient alternative to the traditional ACDF.CTDR using Prestige LP cervical disc provided astatisticallysignificantclinica

160、l,functional,andradiologicaloutcomesbetweenthetwogroupsafter1-yearfollow-up.结论：本研究发现CTDR是一种安全，有效的手术，可以更有效的替代传统的ACDF。使用PrestigeLP颈椎间盘的CTDR在1年随访后有显着统计学的临床，功能和放射学结果改善。*Inthecervicalspine,anteriorcervicaldiscectomyandfusion(ACDF)wasfirstintroducedin1958bySmithandRobinsonandhasbeenthestandardsurgicalproc

161、edurefordegenerativediscdisease.*Furthermore,complicationsofACDF,suchasgraftcollapse,expulsion,pseudo-arthrosis,andinstrumentationfailure, have been frequently reported during the follow-up period. These problems have encouraged thedevelopment of new technology as an alternative to ACDF in cervical

162、degenerative disc disease; therefore,cervicaltotaldiscreplacement(CTDR)hasbeendevisedandutilizedmorefrequentlynow-a-days.*Bypreservingmotionattheoperatedlevel,CTDRhasthepotentialtodecreasetheabnormalkinematicstrainandloadstotheadjacentlevels,andhencedecreasetheoccurrenceofadjacentsegmentdegeneration

163、(ASD).*PreviousstudiesthatcomparedtheclinicaleffectsofCTDRandACDFfortreatingcervicaldegenerativediscdiseasehavereportedambiguousresults.*Ourstudysuggeststhatcervicaltotaldiscreplacementisasafe,effective,andbetteralternativetotraditionalACDFinsingle-leveldegenerativecervicaldiscdisease,providingstati

164、sticallysignificantclinical,functional,andradiologicaloutcomesafter1-yearfollow-up.*ACDF首先于1958年由史密斯和罗宾逊开展，目前是退行性颈椎椎间盘疾病的标准外科手术。*在随访期间，ACDF常常报告有并发症，如内植物塌陷，移位，假关节和内固定断裂。这些问题促进了新技术的发展，作为颈椎退行性椎间盘疾病中的ACDF的替代;因此，现在已经设计并更频繁地使用颈椎间盘置换（CTDR）。*通过保持节段水平的运动，CTDR有可能减少异常的运动应变和负荷到相邻的水平，从而减少相邻节段退化（ASD）的发生。*以前的研究比较C

165、TDR和ACDF的治疗颈椎退行性椎间盘疾病的临床效果报告了不确定的结果。*我们的研究表明颈椎全间盘置换是一个安全，有效，更好的替代传统的ACDF的方法，1年后随访提供统计学显着的临床，功能和放射学结果改善。TITLEPerioperative Complications in 155 Patients WhoUnderwent Oblique Lateral Interbody Fusion Surgery:Perspectives and Indications From a Retrospective,MulticenterSurvey155例OLIF患者的围手术期并发症Departmen

166、tofOrthopaedicSurgery,GraduateSchoolofMedicine,ChibaUniversity,Chiba,JapanStudyDesign.Aretrospectivemulticentersurvey.研究设计：回顾性多中心调查。ABSTRACTObjective.Toinvestigatetheperioperativecomplications of oblique lateral interbodyfusion(OLIF)surgery.目的：探讨斜侧向椎体间融合（OLIF）手术的围手术期并发症。ABSTRACTSummaryofBackgroundDa

167、ta.OLIFhasbeenwidelyperformedtoachieveminimallyinvasive,rigid lumbar lateral interbody fusion. Theassociated perioperative complications are notyetwelldescribed.背景资料：OLIF已被开展，因为可以实现微创，刚性腰椎横向融合。但相关围手术期并发症还没有很好地被描述。ABSTRACTMethods. The participants were patients who underwent OLIF surgery under thedia

168、gnosisofdegenerativelumbardiseasesbetweenApril2013andMay2015at11affiliatedmedicalinstitutions.Thecollecteddatawereclassifiedintointraoperativeand early-stage postoperative (=1 mo) complications. The intraoperativecomplications were then subcategorized into organ damage (neural, vertebral,vascular,an

169、dothers)andothercomplications,mainlyrelatedtoinstrumentalfailure.Thecollecteddatawerealsodividedandanalyzedbasedonwhetherthesurgeonwascertifiedtoperformthesurgeryandtheincidenceofcomplicationsintheearly(April2013March2014)andlatestages(April2014May2015)ofOLIFintroduction.方法：研究对象是2013年4月至2015年5月在11家附

170、属医疗机构接受OLIF手术治疗的退行性腰椎病患者。收集的数据分为术中和术后早期并发症（=1mo）。然后将术中并发症分为器官损伤（神经，脊椎，血管和其他）和其他并发症。收集的数据还根据外科医生在早期（2013年4月-2014年3月）和晚期（2014年4月-2015年5月）进行手术和并发症的发生率进行分类和分析。ABSTRACTResults.Inthe155includedpatients,75complicationswerereported(incidencerate,48.3%).Themost common complication was endplate fracture/subsi

171、dence (18.7%), followed by transientpsoas weakness and thigh numbness (13.5%) and segmental artery injury (2.6%). Almost allthesecomplicationsweretransient,exceptforthreepatientswhohadpermanentdamage:onehadureteralinjuryandtwohadneurologicalinjury.Postoperativecomplicationsincludedsurgicalsiteinfect

172、ion(1.9%)andreoperation(1.9%).Whethertheprimaryoperatorwasexperienceddidnot affect the incidence of complications. Regarding the introductory stage, the incidence ofcomplicationswas50%intheearlystageand38%inthelatestage.结果：在155例包括的患者中，报告了75例并发症（发生率，48.3）。最常见的并发症是终板骨折/沉降（18.7），其次是短暂性腰痛和大腿麻木（13.5）和节段性

173、动脉损伤（2.6）。几乎所有这些并发症是短暂的，除了三个患有永久性损伤的患者：一个输尿管损伤，两个神经损伤。术后并发症包括手术部位感染（1.9）和再手术（1.9）。主要操作者是否有经验影响并发症的发生率。关于入门阶段，并发症的发生率在早期为50，在后期为38。ABSTRACTConclusion.TheoverallincidenceofperioperativecomplicationsofOLIF surgery reached 48.3%, of which only 1.9% resulted inpermanent damage. Our analysis based on surg

174、eon experienceindicated that the OLIF procedure could be performed withoutincreasing incidence of complications, under the guidance ofexperiencedsupervisors.结论：OLIF手术围手术期并发症的总发生率为48.3，其中只有1.9导致永久性损伤。我们基于外科医生经验的分析表明，在有经验的医生的指导下，可以在不增加并发症发生的情况下进行OLIF手术。* In the current retrospective investigation of p

175、erioperative complications of OLIFsurgeryin155patients,theoverallcomplicationratewas48.3%;almostallthesecomplicationsweretransient,butthreepatientshadpermanentdamage(1.9%):onehadureteralinjuryandtwohadneurologicalinjury.* The most common complication was endplate fracture/subsidence (18.7%),followed

176、bytransientpsoasweaknessandthighnumbness(13.5%)andsegmentalarteryinjury(2.6%).*OuranalysisbasedonsurgeonexperienceindicatedthattheOLIFprocedurecouldbeperformedwithoutincreasingincidenceofcomplications,undertheguidanceofexperiencedsupervisors.*在目前对155例患者的OLIF手术围手术期并发症的回顾性调查中，总并发症发生率为48.3;几乎所有这些并发症是短暂

177、的，但三名患者有永久性损伤（1.9）：一名输尿管损伤，两名神经损伤。*最常见的并发症是终板骨折/下沉（18.7），其次是短暂性腰痛和大腿麻木（13.5）和节段性动脉损伤（2.6）。*我们基于外科医生经验的分析表明，在经验丰富的医生的指导下，可以在不增加并发症发生的情况下进行OLIF手术。TITLESurgicalSiteInfectionsinPosteriorLumbarSurgery:AControlled-CohortStudyofEpiduralSteroidPaste后路腰椎手术切口感染：控制性队列研究硬膜外类固醇使用Department of Orthopedic Surgery,

178、 Cleveland ClinicFoundation,Cleveland,OHStudyDesign.Aretrospective,single-centercohortstudyof consecutive patients undergoing posterior lumbardecompressionbetween2007and2013wasconducted.研究设计：对2007年至2013年期间接受后路腰椎减压的连续患者进行回顾性单中心队列研究。ABSTRACTObjective. To compare rates of surgical site infectionbetween

179、matchedcohortsofpatientsundergoinglumbarsurgery with and without intraoperative application ofepiduralsteroidpastes.目的：比较接受腰椎手术的患者的匹配队列与术中应用硬膜外类固醇患者的手术部位感染率。ABSTRACTSummary of Background Data. Epidural steroid agents reducepostoperative pain and inflammation following lumbar surgery,reducing the use

180、 of postoperative narcotics and improving McGillpain scores. Preliminary studies have, however, suggested anincreaseinsurgicalsiteinfectionsfollowingtheuseofthesesteroid-containingpastes.背景资料：硬膜外类固醇药物减少腰椎手术后的术后疼痛和炎症，减少术后麻醉剂的使用和改善McGill疼痛评分。然而，初步研究表明，在使用这些含类固醇的糊剂后，手术部位感染增加。ABSTRACTMethods.Wereviewed7

181、58patientsundergoingdecompressionperformedatasinglecenterbysurgeonswhoeitherroutinelyusedorneverusedananalgesic steroid paste. Patients undergoing instrumentation or revisionsurgery were excluded, and surgical and postoperative protocols wereuniform. Two hundred eighty-three patients met specific in

182、clusion andexclusioncriteria.Demographic,clinical,andsurgicaldatawereassessedand correlated to the incidence of postoperative infections. Multivariatelogisticregressioncontrolledforconfoundingcharacteristicsandidentifiedindependentpredictorsofpostoperativesurgical-siteinfections.方法：我们收集了758例在单个中心进行减

183、压的患者，由外科医生常规使用或不使用止痛类固醇膏。排除了进行翻修手术的患者，并且手术和术后方案是统一的。283名患者符合具体的纳入和排除标准。对人口统计学，临床和手术数据进行评估，评价与术后感染的发生率是否相关。多元逻辑回归控制混杂特性并确定术后手术部位感染的独立预测因子。ABSTRACTResults.Patientdemographics,comorbidities,andperioperativeprotocolsweresimilarbetweengroups.Thereweresixacuteinfectionsamong103patients receiving steroid p

184、aste (5.83%), and two infections among 180patients not receiving paste (1.11%), a statistically significant differencewhichremainedaftercontrollingforconfoundingcharacteristics(oddsratio6.74,P=0.01). All but one infection occurred among patients withidentifiablepreoperativeriskfactorsforinfection.结果

185、：患者人口统计学，合并症和围手术期方案没有组间差异。在接受类固醇膏的患者中有6例急性感染（5.83），180例不接受膏的患者中有2例感染（1.11），在控制混杂特征后保持统计学显着差异（优势比6.74，P=0.01）。ABSTRACTConclusion. The observed increase in infection among patientsreceiving pain paste is clinically significant, but infection wasprimarily observed among at-risk patients. The present st

186、udyconfirms suspicions raised in preliminary studies, and werecommend caution when treating patients with identifiable,comorbidriskfactors.结论：观察到接受硬膜外类固醇治疗的患者中感染的发生率在临床上是显着增加的，但是主要在高风险患者中观察到感染。本研究证实了在初步研究中提出的怀疑，我们建议在治疗有危险因素的患者时要谨慎。* Epidural pastes applied following posterior lumbar decompression ha

187、ve beendemonstratedtorelievepostoperativepainandinflammation.* Smaller series and reviews have suggested an increase in infection riskaccompanyingtheuseofthesepastes,butnoadequatelypoweredinvestigationhasbeenconductedtoconfirmthishypothesis.*Among283patientsanalyzedinthiscohortstudy,asignificantlyhi

188、gherincidenceofinfection(adjustedoddsratio6.74)wasobservedamongpatientsreceivingepiduralpainpastesduringlumbardecompression.* Patients who developed infection typically had identifiable comorbid risk factors(diabetes,obesity,renaldisease).*后路腰椎减压术后应用硬膜外类固醇膏已被证明可缓解术后疼痛和炎症。*较小的数据文章表明使用这些糊剂会增加感染风险，但没有进

189、行充分的调查来证实这一假设。*在本队列研究中分析的283名患者中，在腰椎减压期间接受硬膜外类固醇膏的患者中观察到显着较高的感染发生率（调整优势比6.74）。*感染的患者通常具有可识别的危险因素（糖尿病，肥胖症，肾脏疾病）。TITLECanadian Consensus for the Prevention ofBloodLossinSpineSurgery加拿大对预防脊柱手术出血的共识StudyDesign. Cross-sectional, modified Delphiapproach.StudyDesign：Cross-sectional实验设计：横断面研究ABSTRACTObjecti

190、ve.TheprimaryobjectiveofthisstudywastoidentifypatientsatriskofincreasedperioperativebloodlossaccordingtotheopinionofexpertspinesurgeonsacrossCanada.Thesecondaryobjectivewastoobtaininformationabouttheexpertsapproachonhowtominimizesignificantbloodlossperioperatively.目的：本研究的主要目的是根据加拿大各地脊柱外科专家医生的意见，确定围手

191、术期失血风险增加的患者。次要目的是获得如何最小化围手术期显着失血的方法。ABSTRACTSummary of Background Data：Significant blood loss in majorspinal surgeries has been associated with increased intra- andperioperative complications and costs. The current availableevidence regarding risk factors and preventive measures forincreasedbloodlos

192、sremainsincomplete.背景资料：脊柱手术的主要显著失血与围手术期并发症和费用增加有关。目前关于出血增加的危险因素和预防措施的现有证据仍然不完整。ABSTRACTMethods.A modified Delphi approach was employed to generateconsensusopinionontheriskfactorsandpreventivemeasuresforsignificant blood loss in major spinal surgeries. Twenty-five spinesurgeonsinCanadaparticipatedin

193、thisstudy.方法：采用改进的德尔菲法，对重大脊柱手术中出血的危险因素和预防措施达成共识。25名加拿大脊柱外科医生在参加了这项研究。ABSTRACTResults.Amongvariousfactors,surgeryforthetreatmentofspinetumorsandprolongedoperativetimeofgreaterthan5hourswerefoundtobethemostimportantpredictivefactorsforbloodlossinspinesurgery. Ontheotherhand,appropriatesurgicalhemostas

194、iswas considered the most effective measure for the prevention ofbloodlossinthesesurgeries.结果：在各种因素中，脊柱肿瘤的手术和超过5小时的手术时间被认为是脊柱手术失血最重要的预测因素。另一方面，适当的外科止血被认为是最有效的措施。ABSTRACTConclusion.Werecommendthereductionofbloodlossbymeansofmeticuloushemostasisandshorteroperativetimewhenitissafeand possible. This mig

195、ht result in better treatment outcomes. Itwouldalsoleadtoareductionincostsassociatedwithmajorspinesurgeries and would ultimately lead to greater value-based spinecare.结论：在安全、可行的情况下，建议通过细致止血和缩短手术时间来减少失血量。这可能会促使更好的治疗结果。这也将使与脊柱手术相关的主要成本降低。*Majorspinalsurgerieshavebeenassociatedwithsignificantbloodloss,

196、definedasgreater than 25% of the patients total blood volume. Significant blood loss isassociatedwithincreasedintraandperioperativecomplicationsandcosts.* Prolongedoperative time of greater than five consecutive hours and operationsinvolving treatment of tumors of the spine were found to be the most

197、 reliablepredictivefactorofsignificantbloodlossinspinesurgery.* Spinesurgeons employ several techniques to prevent intraoperative blood loss.Meticuloussurgicalhemostasisintraoperativelywasconsideredasthemosteffectivemeasureforpreventionofbloodlossinspinesurgeries.*脊柱手术显著失血定义为超过25%的病人的总血量。显著失血与术中及围术期

198、并发症和费用增加有关。*超过五个小时的持续手术时间和脊柱肿瘤手术被认为是最可靠的预测因素。脊柱外科医生采用多种技术防止术中失血。细致的手术止血，被认为是在脊柱手术出血时预防的最有效的措施。TITLEMetallosis Presenting as a Progressive Neurologic Deficit Four Years After a Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Case Report金金属属沉沉着着导导致致青青少少年年特特发发性性脊脊柱柱侧侧凸凸后后路路脊脊柱柱融融合合术术四四年年

199、后渐进性的神经功能障碍：病例报告后渐进性的神经功能障碍：病例报告ClevelandClinicFoundation,Cleveland,OHStudyDesign.Acasereport.研究设计：病例报告。研究设计：病例报告。ABSTRACTObjective. The aim of this study was toreport a case of progressive pain andparaparesis secondary to metallosis fouryears after a pediatric posterior spinalfusion(PSF).目的：本研究的目的是

200、报告一个继发小儿脊柱后路融合（PSF）术后金属沉着的疼痛和渐进性截瘫的病例。ABSTRACTSummaryofBackgroundData.Metallosisasalatecomplicationofpediatricspinalsurgeryisrarelyreported.Myelographiccomputedtomography(CT)canbehelpfulinestablishingthediagnosis.Theuseofserumchromiumlevelsasameansofdefinitivediagnosishasbeensuggested,buthasonlybeen

201、reportedretrospectively.背景资料：小儿脊柱手术后金属沉着作为晚期并发症很少报道。脊髓造影CT可以有助于确立诊断。使用血清铬水平测定作为一种明确诊断的手段，但只被回顾性报道。ABSTRACTMethods.A19-year-oldmalepresentedfouryearsafterPSFforadolescentidiopathicscoliosiswithsuddenonsetofpainandneurologicdeficits.RadiographsandCTscansuggestedinfection.Intraoperatively,nopurulentmat

202、erialwasnoted,butblackandyellowishcorrosivedebriswasfoundaroundtherightL1pediclescrew,soitwasremovedandthecavitypackedwithtobramycinimpregnatedcalciumsulfatebeads.Aftersurgery,neurologicdeficitsworsened.CTmyelogramshowedirregularopacificationofthethecalsacattheleveloftheconus.Aposteriorlaminectomyan

203、d decompression was performed with removal of all debris and spinal instrumentation.Metallosiswithinthespinalcanalwasnotedandserumchromiumlevelswereobtained.方法.一个19岁的男性青少年特发性脊柱侧凸患者PSF四年后出现突发性疼痛和神经功能缺损。X线片和CT扫描提示感染。术中没有发现脓性物质，右L1椎弓根螺钉处发现黑色和黄色的腐蚀碎片，所以将它取出并在钉道填充妥布霉素硫酸钙颗粒。术后神经功能障碍加重。CT脊髓造影显示在脊髓圆锥水平硬膜囊不规

204、则混浊。行后路椎板切除减压术，将所有的碎片和脊柱内固定去除。发现椎管内金属沉着，血清铬水平得到证实。ABSTRACTResults.Thepatientwasdischargedoneweekafteradmissionwithimprovement of pain and gradual improvement in neurologicexamination.Threeyearspostdischarge,thepatientisasymptomatic and examination shows bilateral clonus. Serumchromiumlevelsdeclinedf

205、romahighof4.5g/Loperativelyto0.8atfinalfollow-up(normal:0.20.6g/L).结果：术后1周出院，疼痛改善，神经功能逐渐改善。三年后，患者症状和检查显示双侧阵挛。血清铬水平从4.5g/L下降到最终随访时的0.8（正常：0.20.6g/L）。ABSTRACTConclusion.Althoughuncommon,metallosisshouldbeconsideredin the differential diagnosis of any late presenting case of pain,infection-like symptoms, or neurologic deficits after pediatric PSF.CT myelography and serum chromium levels may help guidediagnosis; however, surgical exploration is needed for definitivediagnosisandtreatment.结论：虽然少见，但metallosis应在小儿PSF的神经功能缺损时与感染等症状作鉴别诊断。脊髓CT造影和血清铬水平可帮助诊断；然而，手术探查是诊断和治疗所必须的。